Background
Disclosing prognostic information is necessary to enable patients to make well‐informed treatment decisions. OncologIQ is a prognostic model that predicts the overall survival (OS) ...probability in patients with head and neck squamous cell carcinoma (HNSCC). We aimed to externally validate and update the model with new prognostic factors and translate it to a clinically useful tool.
Methods
A consecutive retrospective sample of 2189 patients eligible for curative treatment of a primary HNSCC were selected. Discriminative performance was determined using the C‐statistic.
Results
External validation showed systematic underestimation of OS in the new population, and reasonable discrimination (C‐statistic 0.67). Adding smoking, pack years, BMI, weight loss, WHO performance, socioeconomic status, and p16 positivity to the recalibrated multivariable model, improved the internally validated C‐statistic to 0.71. The model showed minor optimism and was translated in an online tool (www.oncologiq.nl).
Conclusions
The updated model enables personalized patient counseling during treatment decision consultations.
Major extracranial injury (MEI) is common in traumatic brain injury (TBI) patients, but the effect on outcome is controversial.
To assess the prognostic value of MEI on mortality after TBI in an ...individual patient data meta-analysis of 3 observational TBI studies (International Mission on Prognosis and Clinical Trial Design in TBI IMPACT), a randomized controlled trial (Corticosteroid Randomization After Significant Head Injury CRASH), and a trauma registry (Trauma Audit and Research Network TARN).
MEI (extracranial injury with an Abbreviated Injury Scale ≥ 3 or requiring hospital admission) was related to mortality with logistic regression analysis, adjusted for age, Glasgow Coma Scale motor score, and pupil reactivity and stratified by TBI severity. We pooled odds ratios (ORs) with random-effects meta-analysis.
We included 39,274 patients. Mortality was 25%, and 32% had MEI. MEI was a strong predictor for mortality in TARN, with adjusted odds ratios of 2.81 (95% confidence interval CI, 2.44-3.23) in mild, 2.18 (95% CI, 1.80-2.65) in moderate, and 2.14 (95% CI, 1.95-2.35) in severe TBI patients. The prognostic effect was smaller in IMPACT and CRASH, with pooled adjusted odds ratios of 2.14 (95% CI, 0.93-4.91) in mild, 1.46 (95% CI, 1.14-1.85) in moderate, and 1.18 (95% CI, 1.03-1.55) in severe TBI. When patients who died within 6 hours after injury were excluded from TARN, the effect of MEI was comparable with IMPACT and CRASH.
MEI is an important prognostic factor for mortality in TBI patients. However, the effect varies by population, which explains the controversy in the literature. The strength of the effect is smaller in patients with more severe brain injury and depends on time of inclusion in a study.
Background
The aim of this study was to identify risk factors for the development of second primary tumors (SPTs) in the head and neck region, lungs, and esophagus in patients with head and neck ...cancer.
Methods
We collected data from 1581 patients. A cause‐specific Cox model for the development of an SPT was fitted, accounting for the competing risks residual/recurrent tumor and mortality.
Results
Of all patients, 246 (15.6%) developed SPTs. Analysis showed that tobacco and alcohol use, comorbidity, and the oral cavity subsite were risk factors for SPTs. The C‐index, the discriminative accuracy, of the model for SPT was 0.65 (95% confidence interval, 0.61–0.68).
Conclusions
Our results show that there is potential to identify patients who have an increased risk to develop an SPT. This might increase their survival chances and quality of life. More research is needed to provide head and neck clinicians with definitive recommendations.
The EuroQol Group 5-Dimension Self-Reported Questionnaire (EQ-5D) is a well-established instrument to assess quality of life and generates generic utility values for health states reported by ...patients, derived from assessments by the general public. We hypothesized that language problems and other nonmotor deficits are not captured as well as motor deficits by this system. We aimed to quantify the association between disabling neurologic deficits and the EQ-5D dimension scores and the utility score in patients with ischemic stroke.
We used data of the Interventional Management of Stroke III trial. Missing data were imputed by multiple imputation. The association between neurologic deficits (individual NIH Stroke Scale NIHSS item scores) and the EQ-5D-3L (5 three-level dimension scores and utility score) at 90 days was assessed with ordinal logistic regression and Tobit regression, respectively. The explained variance of each model was estimated with Nagelkerke pseudo-R
or R
.
In total, 525 surviving patients were included. Complete data on both the NIHSS and EQ-5D were available for 481/525 (91.6%) patients. At 90 days, 161/491 (32.8%) patients had aphasia and 226/491 (46.0%) patients had paresis of at least 1 limb. Limb paresis, facial palsy, sensory loss, and dysarthria explained most of the variance in all EQ-5D dimension scores and the utility score. In the utility score, 8.9% of the variance was explained by neglect, 10.0% by aphasia, 10.8% by hemianopia, and 17.5%-24.1% by limb paresis.
The impact of neurologic deficits on the EQ-5D in patients with ischemic stroke is mostly due to limb paresis, while the EQ-5D is less sensitive to other nonmotor deficits such as hemianopia, aphasia, and neglect. This may lead to overestimation of quality of life and, consequently, underestimation of the (cost-)effectiveness of treatments and interventions.
ClinicalTrials.gov. Unique identifier: NCT00359424.
BackgroundEfforts to mitigate unwarranted variation in the quality of care require insight into the ‘level’ (eg, patient, physician, ward, hospital) at which observed variation exists. This ...systematic literature review aims to synthesise the results of studies that quantify the extent to which hospitals contribute to variation in quality indicator scores.MethodsEmbase, Medline, Web of Science, Cochrane and Google Scholar were systematically searched from 2010 to November 2023. We included studies that reported a measure of between-hospital variation in quality indicator scores relative to total variation, typically expressed as a variance partition coefficient (VPC). The results were analysed by disease category and quality indicator type.ResultsIn total, 8373 studies were reviewed, of which 44 met the inclusion criteria. Casemix adjusted variation was studied for multiple disease categories using 144 indicators, divided over 5 types: intermediate clinical outcomes (n=81), final clinical outcomes (n=35), processes (n=10), patient-reported experiences (n=15) and patient-reported outcomes (n=3). In addition to an analysis of between-hospital variation, eight studies also reported physician-level variation (n=54 estimates). In general, variation that could be attributed to hospitals was limited (median VPC=3%, IQR=1%–9%). Between-hospital variation was highest for process indicators (17.4%, 10.8%–33.5%) and lowest for final clinical outcomes (1.4%, 0.6%–4.2%) and patient-reported outcomes (1.0%, 0.9%–1.5%). No clear pattern could be identified in the degree of between-hospital variation by disease category. Furthermore, the studies exhibited limited attention to the reliability of observed differences in indicator scores.ConclusionHospital-level variation in quality indicator scores is generally small relative to residual variation. However, meaningful variation between hospitals does exist for multiple indicators, especially for care processes which can be directly influenced by hospital policy. Quality improvement strategies are likely to generate more impact if preceded by level-specific and indicator-specific analyses of variation, and when absolute variation is also considered.PROSPERO registration numberCRD42022315850.
The aim of this study was to assess the relative contributions of psychopathic, narcissistic, Machiavellian, and sadistic traits to delinquent behaviors in adolescents. Participants were 615 ...high-school students who completed self-report questionnaires. Psychopathic, narcissistic, Machiavellian, and sadistic traits were moderately correlated suggesting they may be overlapping but distinct constructs. Hierarchical multiple regression analyses were conducted to control for other socio-familial or psychopathological risk factors. Psychopathic and sadistic traits were independent predictors of delinquent behaviors in boys only. These findings suggest the importance of studying the role of sadistic traits in juvenile delinquency.
Stratification and minimisation are useful methods to ensure balance of risk factors between treatment arms.2–4 These methods can be beneficial in small and large trials, but for trials larger than ...1000 patients little effect of minimisation on imbalance was found as compared with simple randomisation.4 One of the assumptions of Fisher’s exact test is that samples are random and independent, which is not the case in this study. The correlation between observations violates the independence assumption and will lead to standard errors (SE) that are biased upwards because tests for independent samples do not account for this correlation and will overestimate the variance of the treatment effect. While adjustment is possible using Fisher’s exact test,7 8 we suggest performing logistic regression analysis as this allows adjustment for multiple minimisation variables, does not rely on inefficient stratification,8 and can be used to determine the confidence interval around the treatment effect estimate.
Background:
The International Consortium for Health Outcomes Measurement has selected the self-administered comorbidity questionnaire (SCQ) to adjust case-mix when comparing outcomes of inflammatory ...bowel disease (IBD) treatment between healthcare providers. However, the SCQ has not been validated for use in IBD patients.
Objectives:
We assessed the validity of the SCQ for measuring comorbidities in IBD patients.
Design:
Cohort study.
Methods:
We assessed the criterion validity of the SCQ for IBD patients by comparing patient-reported and clinician-reported comorbidities (as noted in the electronic health record) of the 13 diseases of the SCQ using Cohen’s kappa. Construct validity was assessed using the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life, IBD-related healthcare and productivity costs, prevalence of disability, and IBD disease activity. We assessed responsiveness by correlating changes in the SCQ with changes in healthcare costs, productivity costs, quality of life, and disease activity after 15 months.
Results:
We included 613 patients. At least fair agreement (κ > 0.20) was found for most comorbidities, but the agreement was slight (κ < 0.20) for stomach disease κ = 0.19, 95% CI (−0.03; 0.41), blood disease κ = 0.02, 95% CI (−0.06; 0.11), and back pain κ = 0.18, 95% CI (0.11; 0.25). Correlations were found between the SCQ and the clinician-reported SCQ ρ = 0.60, 95% CI (0.55; 0.66), CCI ρ = 0.39, 95% CI (0.31; 0.45), the prevalence of disability ρ = 0.23, 95% CI (0.15; 0.32), and quality of life ρ = −0.30, 95% CI (−0.37; −0.22), but not between the SCQ and healthcare or productivity costs or disease activity (|ρ| ⩽ 0.2). A change in the SCQ after 15 months was not correlated with a change in any of the outcomes.
Conclusion:
The SCQ is a valid tool for measuring comorbidity in IBD patients, but face and content validity should be improved before being used to correct case-mix differences.
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